1 / 10

MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to:

MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: Data Quality Management Conference. MERHCF Defined. Established by Congress (2001 NDAA) to provide mandatory funding for a health care entitlement ( Title 10, Subtitle A, Part II, Chapter 56, United States Code )

martin-cross
Download Presentation

MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: Data Quality Management Conference

  2. MERHCF Defined • Established by Congress (2001 NDAA) to provide mandatory funding for a health care entitlement (Title 10, Subtitle A, Part II, Chapter 56, United States Code) • Covers certain Medicare-eligible DoD beneficiaries(military retirees, retiree family members and survivors - not simply “over-65s”) • Pays for MTF care, purchased care and pharmacy • Recognizes DoD’s accrued and future liability for cost of retiree/survivor health care for military service members and their family members • The DoD MERHCF Board of Actuaries determines funding requirements based on actuarial analyses and assumptions, including population characteristics such as: • Rates of retention to retirement eligibility, tendency to remain on active duty beyond retirement eligibility, life expectancy, family size, age-related demand for health care, etc. Implemented 1 October 2002 (FY03)

  3. TFL/TSRx ≠ MERHCF TSRx TFL MERHCF TRICARE for Life (TFL) – Age 65 or over, Medicare eligible, enrolled in Part B, not Active Duty TRICARE Senior Pharmacy (TSRx) - Age 65 or over, Medicare eligible, enrolled in Part B (unless age 65 or older as of 1 April 2001), not Active Duty MERHCF – Medicare eligible retirees, retiree family members and survivors only, regardless of age or Part B enrollment status Other key differences include: MERHCF pays for Military Treatment Facility (MTF) care; TFL/TSRx do not MERHCF pays for Uniformed Services Family Health Plan (USFHP) costs; TFL/ TSRx do not

  4. MERHCF Revenue Sources Annual DoD actuarial “Normal Cost” contribution Dept of Treasury actuarial liability - $516.5B amortized over 50 years ($12.9B) FY08 ($11.2B FY08) Accrual fund investment earnings FY08 Estimated Outlays $8.3B ($1.7B Direct Care; $6.6B Purchased Care)

  5. Normal Cost Contribution Paid by Treasury on behalf of Service MILPERS accounts • FY08 per capita rates: • Full time $499 per month ($5,988 annually) • Part time $287 per month ($3,441 annually) • Multiplied by annual budgeted Service end strength • FY08 actual total DoD contribution - $11.2B • Pays forfuturehealth care costs of current military personnel once they retire and they and their family members/survivors become eligible for Medicare

  6. Simultaneous Reconciliation Purchased Care TRICARE for Life* -Medicare primary payor, TRICARE supplemental (last) payor (must be enrolled in Medicare Part B) plus TRICARE unique benefits (OCONUS purchased care) Managed Care Support (MCS) Contracts* -network at-risk costs (under 65 Medicare eligibles – must be enrolled in Part B) TRICARE Senior Pharmacy* -retail, TMOP costs (must be enrolled in Part B, unless “grandfathered” – age 65 or older as of 1 April 2001) USFHP -enrollees x capitation rate * Includes claims processing and other administrative costs Funds flow: Daily transactions against accrual fund for appropriate charges

  7. Direct (MTF) Care Inpatient Care -Relative Weighted Products (RWPs) x MTF-specific rate (Medical Expense and Performance Reporting System (MEPRS) cost/RWP) Outpatient Care -Ambulatory Patient Group (APG) weights x MTF-specific rate (MEPRS cost/APG weight) Outpatient Pharmacy -“Ingredient cost” - purchase costs from MEPRS; patient-specific workload from Pharmacy Data Transaction Service (PDTS) “Non-ingredient cost” – MTF-specific MEPRS cost/script Move to per capita rate when feasible

  8. MTF Funds Flow Prospective/interim annual payment at beginning of FY (distributed quarterly) Defense Health Program O&M Fund > USD(C) > TMA > Services > MTFs MILPERS Fund > Treasury Appropriation > Services

  9. MTF Reconciliation The plan… Results used to adjust future prospective payment amount SIDR completion timeliness delays Execution Review to 3d Qtr of following year Execution Review FY03 - Year of Execution FY04 - 1 Year Post Execution FY05 - 2 Years Post Execution Use results of the Execution Review to adjust prospective payment amounts in the next available budget year under the PPBS cycle; do not transfer money to or from the fund based on execution year under/over execution Provides stable business environment for MTFs

  10. Management Controls • Center for Medicare and Medicaid Services (CMS) Medicare eligibility data merged with Defense Enrollment Eligibility Reporting System (DEERS) (system change request (SCR) added Medicare eligibility to Standard Inpatient Data Record (SIDR) and Standard Ambulatory Data Record (SADR)) • MTF earnings calculations automated based on SIDR/SADR weighted workload reported in MHS Data Repository (MDR); final results subject to Service and TMA review at reconciliation

More Related